Payment Form

Payment Form

To ensure your payment is processed efficiently please complete all fields.

It's essential to itemize your payment details clearly.
This helps us attribute your payment to the correct account and for the intended purpose.
Student's Name*
First Name Last Name
E-mail
Phone Number

Area Code Phone Number
Purpose of Payment* Please specify the reason for your payment. For example, tuition fees, field trip, lunch, etc.
Select One

This payment is a donationThis payment is for goods or services provided
Amount Paying*

$
Total

$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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